Project Summary Alzheimer?s disease (AD) is the most common form of dementia, the most common neurodegenerative disease in older adults, and the 6th leading cause of death in the US. Neuropsychiatric symptoms (apathy, depression, anxiety) and altered gait and balance are prominent secondary symptoms of AD that increase medical costs and decrease quality of life (QoL) for the person with dementia and their caregiver. Care for AD and other dementias in the US was estimated at $203 billion in 2013. Palliative care services are health services that aim to relieve disease symptoms that decrease QoL for people with chronic disease and their caregivers. The World Health Organization has identified a need to integrate evidence-based palliative care services into the continuum of care for serious chronic diseases including AD. However, two recent NIH workshops concluded that lack of evidence limits the broader use of non-pharmacologic activities to relieve secondary symptoms of chronic disease, and identified arts-based mind-body practices as particularly understudied. Dance is an arts- based activity that can improve QoL, decrease symptoms of depression, and improve balance in healthy older adults, those with Parkinson disease, and AD. Thus, dance simultaneously addresses two sets of prominent secondary symptoms in AD: 1) gait and balance and 2) neuropsychiatric symptoms. However, the mechanisms by which dance exerts these effects are unknown. Filling this knowledge gap could increase the use of dance to improve QoL in a large and growing patient population. In addition, a better understanding of the physiological changes that occur during dance that are linked to improved QoL and symptom management could facilitate identification of other interventions that may ameliorate secondary symptoms of AD, and other patient populations that might benefit from dance. We present pilot data to support our hypothesis that dance improves QoL in older adults with AD through changes in brain activity in brain networks related to movement and social engagement. We hypothesize that dance benefits QoL by simultaneously improving balance and gait through movement, and improving apathy and depression through social engagement. We have laid out a rigorous scientific design to test the independent contributions of dance movement and social engagement to QoL. In addition, we propose to collect measures that will allow us to learn about how dance affects different body systems. We will collect brain imaging data to evaluate changes in brain function and structure; detailed measures of balance and gait; and blood biomarkers of stress. Better understanding of how dance affects the body and brain to improve quality of life in people with AD may improve the quality of palliative care services offered to people with AD by helping to understand how to better use non-pharmacologic interventions to target secondary symptoms that affect QoL.